移植肾急性排斥反应中Th1/Th2细胞因子的动态变化

摘要

背景：单一细胞因子在移植前后两点的变化不具有诊断急性排斥的临床意义，联合监测细胞因子可更好地判断移植患者的体内免疫状态。目的：观察Th1/Th2细胞因子在肾移植前后的动态变化趋势，探讨其在急性排斥时的临床应用价值。方法：采用前瞻性队列研究，用双抗体夹心酶联免疫吸附法(ELISA)检测肾移植前、肾移植后3，7，14 d时急性排斥组和非急性排斥组体内Th1和Th2细胞因子水平进行动态的监测。结果与结论：在肾移植前，急性排斥组Th1(γ-干扰素、白细胞介素12)细胞因子水平明显高于非急性排斥组，差异有显著性意义(P <0.05)；Th2(白细胞介素4、白细胞介素10)细胞因子水平低于非急性排斥组，差异有显著性意义(P <0.05)。肾移植后，非急性排斥组各时点的Th1和Th2细胞因子水平无明显变化；急性排斥组各时点Th1细胞因子迅速升高，在排斥前达峰值，各时点Th1细胞因子水平明显高于非急性排斥组；Th2细胞因子水平缓慢升高，在排斥前达高峰，各时点Th2细胞因子水平仍低于非急性排斥组。结果可见，非急性排斥患者肾移植前后体内Th1/Th2细胞因子保持稳态，而急性排斥患者肾移植前后体内Th1/Th2细胞因子呈非稳态分布趋势，表现为Th1细胞因子在排斥前迅速升高，Th2细胞因子缓慢升高。%BACKGROUND:The changes of single cytokine before and after transplantation has no clinical significance in the diagnosis of acute rejection, but the joint monitoring of cytokines is better to determine the immune status of transplanted patients. OBJECTIVE:To observe the dynamics changes of Th1/Th2 cytokines before and after transplantation in order to investigate the clinical significance in the diagnosis of acute rejection. METHODS:It was a prospective cohort study. The Th1 and Th2 cytokine levels in the rejection group and non-rejection group were dynamical y monitored with double-antibody sandwich enzyme-linked immunosorbent assay before, and 3, 7 and 14 days after transplantation. RESULTS AND CONCLUSION:Before renal transplantation, the Th1 (γ-interferon and interleukin-12) cytokine levels in the rejection group were significantly higher than those in the non-rejection group (P<0.05);the Th2 (interleukin-4 and interleukin-10) cytokine levels in the rejection group were significantly lower than those in the non-rejection group (P<0.05). After renal transplantation, there were no significant changes in Th1 and Th2 cytokines levels of the non-rejection group at different time points;the Th1 cytokine levels in the rejection group were increased rapidly at different time points, and reached a peak before acute rejection, and the Th1 cytokine levels at different time points in the rejection group were significantly higher than those in the non-rejection group;the Th2 cytokines were increased gradual y in the rejection group, and reached a peak before acute rejection, and the Th2 cytokine levels at different time points in the rejection group were stil lower than those in the non-rejection group. The results showed that the Th1/Th2 cytokines in the non-rejection group were kept stably before and after renal transplantation, but not in the rejection group, in which, the Th1 cytokines were increased rapidly before acute rejection and the Th2 cytokines were increased gradual y.